Behavioral Health Research
CAIH's behavioral research and interventions have been developing since the early 1990s. Projects have included studying the behavioral and environmental determinants of priority health problems, including: suicide, alcohol abuse, teen pregnancy and the high school dropout rate. Current studies include: a large-scale, family-strengthening intervention for reservation-based teen moms, a youth suicide prevention study, and a postpartum depression prevention study for young reservation-based teen moms.

Cradling our Future through Family Strengthening
This study, funded by the National Institute on Drug Abuse (NIDA), is a 5-year randomized controlled trial investigating the efficacy of an in-home, family-strengthening intervention called Family Spirit in 320 expectant American Indian teens in 4 tribal communities. Teen mothers (aged 12-19 years) are recruited by 28 weeks gestation and are randomly assigned to receive the Family Spirit Intervention (FS)+Optimized Standard Care vs. Optimized Standard Care (OSC) alone. FS is an intervention which utilizes a Center-developed manual, consisting of 40 comprehensive curricular sections (taught in 40 visits) delivered in the home of the study participant by community paraprofessionals called “Family Health Educators” (FHEs), and also includes 6 social support visits and 6 visits for guided assistance by FHEs in accessing community services (total visits=52). OSC consists of transportation assistance for participants to and from scheduled IHS prenatal and well baby visits by Family Health Liaisons (FHLs). In conjunction with transportation assistance in OSC, FHLs collect interim history and provide mothers with informational pamphlets on prenatal and child care topics.  The Cradling our Future study is operating on the Navajo, White Mountain Apache and San Carlos Apache reservations in the following communities: Navajo—Tuba City, Fort Defiance, Gallup; Apache—Whiteriver, San Carlos. All participants are served until their baby’s second birthday and are followed up until the baby’s third birthday.  For more information on the Cradling our Future study, please contact Allison Barlow at(410) 955-6931.

Celebrating Life Study
This study, funded through the Native American Research Centers in Health [NARCH] mechanism, is a 4 year community-based investigation of youth suicide on the White Mountain Apache reservation.  CAIH is working in partnership with the Tribal Suicide Prevention Coalition to accomplish the following tasks:

• Enhance the existing tribal suicide registry data collection system
  
• Design new suicide registry data collection forms
  
• Interview 75 youth (aged 10-19 years) who have made a recent suicide attempt to understand key determinants and risk factors leading up to their attempt
  
• Complete extensive follow up interviews over the course of 1 year with 25 youth (aged 10-19) who have made a recent suicide attempt to gather additional in-depth ethnographic information on suicidal youths’ interactions with family, school (or work settings), health care and other services, peers or intimate partners, and conceptions of self (physical, emotional, spiritual, behavioral), and preferences and experiences with local treatment services.
  
• Engage community experts and opinion leaders in applying lessons learned throughout the study to the selection and adaptation of empirically supported prevention intervention(s) that will be tested through future NIH-funded research grants.

Additional funding has been received from the Substance Abuse Mental Health Services Administration (SAMHSA) through appropriations from the Garrett Lee Smith Memorial Act to expand Celebrating Life efforts through community-directed suicide prevention initiatives organized as a three-tiered prevention approach.

• Tier one focuses on community education and awareness about suicide risk factors and prevention for the general public.  Community meetings and local media will be used in this effort.
• Tier two involves targeted prevention outreach with youth with risk factors, and their parents.  Strategies such as life skills workshops will be used to reach and serve at-risk youth and their parents.
• Tier three is targeted on reducing risk of completion or future attempts for youth who have attempted suicide.  Outreach programs will include a family-centered home-visiting program that will use an adapted life skills curriculum that has been proven effective among other tribes.  We will also adapt a nationally proven program for crisis intervention for youth and their families who come to the hospital for care after an attempt.

Funding for this initiative is over 3 years.  If you are interested in learning more about any facet of the Celebrating Life work, please contact Allison Barlow at (410) 955-6931.

Living in Harmony
This study, funded by the National Institute of Mental Health, is a 3-year randomized controlled trial examining the effectiveness of an in-home post-partum depression prevention intervention called Living in Harmony.  Teen moms (aged 15-19 years old) on the White Mountain Apache reservation are recruited by 28 weeks gestation and are randomized to receive 8 Living in Harmony lessons, based on cognitive-behavioral therapy, to prevent the onset of post-partum depression, or 8 Educational Support lessons to prepare them for upcoming motherhood.  All mothers and babies are followed up until the baby’s six-month birthday.  We anticipate serving 62 mothers in this trial.  For more information about the Living in Harmony study, please contact Elena Varipatis Baker at (410) 502-5612.

Family Spirit Project - Outreach to Young Families
CAIH has recently made large strides in its goal of disseminating the Family Spirit program to tribal nations across the country.  Currently, we are involved in two efforts toward this goal:

• CAIH has recently partnered with the Chinle Service Unit to offer the Family Spirit program as a service to young moms living in the Chinle community on the Navajo Nation.  Family Spirit is an in-home family strengthening program that was developed by CAIH in partnership with the Navajo and White Mountain Apache tribes. The program employs local indigenous field workers who are trained to do regular home visits to assist teen mothers, and fathers—when present—to learn about nutrition, breast-feeding, well baby-care, parenting skills, injury prevention, family planning, and STI prevention. The service is provided from the beginning of the mother's third trimester through her baby's first birthday. While more than 1,000 young families have received Family Spirit to date, this marks the first time that Family Spirit is being offered strictly as a service project with no research component. 
  
• CAIH was very excited to be contracted by the Indian Health Service Head Start Bureau to begin adapting the Family Spirit program for use in tribally-run Early Head Start offices.  In addition to making adaptations to match Early Head Start performance standards, CAIH plans to train Early Head Start employees from 5 tribally-run Early Head Start centers to administer Family Spirit to their constituents.

FAMILY SPIRIT PROJECT
The Family Spirit Project is the first family strengthening program of its size and scope in Indian Country.  It is run by local, indigenous Family Health Educators who have been trained by public health experts from Johns Hopkins to counsel and support young Indian parents.

The goals of the program are to help parents:

• Increase knowledge and skills to care for their baby's health and physical, mental and emotional health
• Access community resources, especially education and employment, to meet their individual goals
• Work on ways to strengthen relationships with partners and family members
• Address any personal issues such as substance abuse or legal problems that hinder their wellness 

The Family Spirit curriculum includes lessons covering developmentally appropriate topics from pregnancy through the baby’s first birthday.  The following chart offers a glimpse at some of Family Spirit’s 30 lessons

FAMILY SPIRIT IN THE HOME
Family Spirit provides in-home education to young parents by counselors who meet clients in their homes and work one-on-one to teach infant care, parenting, life-skills and self-help.  Interested clients are enrolled by the FHEs by 28 weeks gestation and served until their baby is 1 year old.  FHEs also help parents connect with other support services within their communities.

FAMILY SPIRIT AND COMMUNITY EMPOWERMENT
A longtime goal of the Family Spirit program is to e package the program so other tribes across the country can use it in their communities.  CAIH staff are working with tribal and national experts to design a blueprint for tribal takeover of the program.  The goal is to ensure the quality of and funding for the program over the long haul.

NEED MORE INFORMATION?
If you would like more information about The Family Spirit Project, please contact the Allison Barlow or Elena Varipatis Baker at (410) 955-6931.

Johns Hopkins Center for American Indian Health
621 N Washington St.
Baltimore, MD 21205
phone: (410) 955-6931
fax: (410) 955-2010 
email: abarlow@jhsph.edu
email: evaripat@jhsph.edu

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